What is the best antibiotic for eye infections in patients with contact lens use?

From the Guidelines

For eye infections while wearing contacts, fluoroquinolone antibiotics like moxifloxacin (Vigamox) or gatifloxacin (Zymaxid) are typically the best options, as they provide broad-spectrum coverage against common eye pathogens and have good penetration into eye tissues 1.

Key Considerations

• These antibiotics are usually prescribed as eye drops to be used every 2-4 hours initially, then tapered as symptoms improve, generally for 7-10 days.
• It is essential to remove contacts immediately at the first sign of an eye infection and avoid wearing them until the infection has completely cleared and a doctor approves resuming use.
• When using antibiotic eye drops, it is recommended to wait at least 15 minutes after application before reinserting contacts.
• Fluoroquinolones are particularly effective against Pseudomonas, which can cause serious infections in contact lens wearers 1.

Important Notes

• Always consult an eye care professional before using any antibiotic, as they will need to determine if the infection is bacterial and requires antibiotics or if it is another condition needing different treatment.
• The choice of antibiotic may be guided by the results of smears and the severity of the infection, with fortified antibiotics considered for large and/or visually significant corneal infiltrates 1.
• Systemic antibiotics are rarely needed but may be considered in severe cases where the infectious process has extended to adjacent tissues or when there is impending or frank perforation of the cornea 1.

From the FDA Drug Label

Gatifloxacin ophthalmic solution, 0.5% is a clear, pale yellow, sterile, preserved aqueous solution with an osmolality of 260- 330 mOsm/kg and a pH of 5.1-5. Gatifloxacin has been shown to be active against most isolates of the following organisms both microbiologically and clinically, in conjunctival infections: Aerobic gram-positive bacteria: Staphylococcus aureus Staphylococcus epidermidis Streptococcus mitis group* Streptococcus oralis* Streptococcus pneumoniae Aerobic gram-negative bacteria: Haemophilus influenzae Ofloxacin has in vitro activity against a broad range of gram-positive and gram-negative aerobic and anaerobic bacteria Ofloxacin is bactericidal at concentrations equal to or slightly greater than inhibitory concentrations.

Best Antibiotic for Eye Infections with Contact Use:

• Gatifloxacin and Ofloxacin are both effective antibiotics for the treatment of bacterial conjunctivitis.
• Gatifloxacin has been shown to be clinically superior to its vehicle in patients with conjunctivitis and positive conjunctival cultures, with a clinical success rate of 58% 2.
• Ofloxacin has been shown to be superior to its vehicle after 2 days of treatment in patients with conjunctivitis and positive conjunctival cultures, with a clinical improvement rate of 86% 3.
• However, the best antibiotic for eye infections with contact use cannot be determined with certainty, as the FDA label does not provide a direct comparison between the two antibiotics in this specific context.
• It is essential to consult a healthcare professional to determine the most suitable antibiotic for a particular eye infection, considering factors such as the causative organism, severity of the infection, and individual patient needs.

From the Research

Antibiotic Options for Eye Infections with Contact Use

• Moxifloxacin is a potential treatment for eye infections, with studies showing its effectiveness against a broad range of microbial species 4, 5.
• The development of sustained-release moxifloxacin loaded commercial soft hydrogel contact lenses has been explored as a potential treatment for eye infections, with some contact lenses showing high drug loading and adequate controllable drug release for 24 hours 4.
• Gatifloxacin has also been shown to have broad-spectrum activity against ocular pathogens, including gram-positive, gram-negative, and atypical bacterial species 6.
• Resistance rates to ciprofloxacin, gentamicin, and cephalosporins vary by geographic region, with lower resistance rates reported in Australia and higher resistance rates reported in the Indian subcontinent and South America 7.
• Susceptibility testing of clinical isolates of Pseudomonas aeruginosa to levofloxacin, moxifloxacin, and gatifloxacin has shown that while most isolates are susceptible, significant numbers are resistant, highlighting the need for clinicians to be aware of potential resistance 8.

Key Findings

• Moxifloxacin has been shown to be effective against a broad range of microbial species, including gram-positive, gram-negative, and atypical bacterial species 4, 5.
• Gatifloxacin has broad-spectrum activity against ocular pathogens, including gram-positive, gram-negative, and atypical bacterial species 6.
• Resistance rates to antibiotics vary by geographic region, highlighting the need for clinicians to be aware of local resistance patterns 7, 8.

Contact Lens Considerations

• The development of sustained-release moxifloxacin loaded commercial soft hydrogel contact lenses has been explored as a potential treatment for eye infections, with some contact lenses showing high drug loading and adequate controllable drug release for 24 hours 4.
• The use of contact lenses as a delivery system for antibiotics may offer a potential treatment option for eye infections, but further research is needed to fully explore this approach 4.